Provider Engagement Account Manager – Behavioral Health

Role Overview

• Maintain and strengthen partnerships between the health plan and the contracted Behavioral Health provider networks serving our communities
• Serve as a strategic consultative liaison ensuring delivery of the highest level of care to our members
• Engage with providers to align network performance opportunities and solutions, and consultative account management and accountability for issue resolution
• Drive optimal performance incentive performance, quality, and cost utilization
• Serve as primary contact for providers and act as a liaison between the providers and the health plan
• Receive and effectively respond to external provider related issues
• Completes special projects as assigned
• Ability to travel locally 2-4 days a week
• Complies with all policies and standards
• Conducts regular in-person and virtual visits with Behavioral Health physicians to provide real-time support for Claims, Credentialing, and Care Management, UM, Network, and Compliance
• Educate providers regarding policies and procedures related to referrals, claims submission, credential documentation, self-service tools, websites, Electronic Health Records, Health Information Exchange, and Electronic Data Interface
• Investigate, document, and drive resolution of Behavioral Health provider concerns, ensuring timely follow-up and clear communication
• Receive, triage, and resolve provider-related issues in coordination with internal partners including claims, credentialing, care management, utilization management, network, and compliance
• Build and sustain collaborative, solution-oriented partnerships that enhance provider satisfaction and network stability
• Ensure effective escalation and tracking of issues through closure
• Translate complex claims and utilization data into clear, actionable insight for providers and internal stakeholders
• Partner with analytics, finance, and operations teams to ensure data accuracy and alignment
• Perform other duties as assigned

Requirements

• Bachelor’s degree in related field or equivalent experience
• Two years of managed care or medical group experience, provider relations, quality improvement, claims, contracting utilization management, or clinical operations
• Project management experience at a medical group, IPA, or health plan setting
• Proficient in HEDIS/Quality measures, cost and utilization
• Direct experience working with Behavioral Health providers (psychiatry, therapy, substance use, crisis services, etc.) strongly preferred
• Minimum of two (2) years of provider engagement or account management experience, preferably within Behavioral Health in a health plan, IPA, medical group, or similar healthcare setting
• Hands-on experience supporting provider operations, including claims processing and analysis, billing workflows, credentialing, and provider office management
• Demonstrated ability to analyze and interpret claims and utilize data to identify trends, resolve provider issues, and support performance improvement discussions
• Experience collaborating cross-functionally with Claims, Network, Credentialing, Care Management, and Compliance teams to drive issue resolution and performance outcomes

Benefits

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• flexible approach to work with remote, hybrid, field or office work schedules